Preferred Name

Stanley W. Hatcher

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Date of Graduation


Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing


Erica Lewis

Shawn Craddock


Many Americans are dependent on or misuse prescription opioids. Increasing opioid misuse and opioid use disorder rates have led to record opioid-related deaths in recent years. Provider prescribing practices are one part of the problem. Evidence indicates that prescribers should assess for risks related to substance misuse and abuse in high-risk populations, such as patients on long-term opioid therapy. By evaluating risk level, the provider will have additional information to guide treatment decisions and a baseline for assessing future changes in risk status. Identifying high-risk patients is a first step in promoting quality care for this population. This project used quality improvement methods to study the implementation of an opioid risk screening tool in a rural pain management clinic. Addiction screening was implemented in two iterative Plan-Do-Study-Act (PDSA) cycles, first with one clinic provider (Cycle 1) and then with four clinic providers (Cycle 2). The project included all patients seen by the participating providers who met inclusion criteria. Participants completed an anonymous paper version of the Opioid Risk Tool-Opioid Use Disorder (ORT-OUD) as part of their intake assessment paperwork. The Primary Investigator (PI) recorded the number of eligible patients and the number of patients who completed the screening. At the end of each cycle, the PI interviewed providers to identify barriers to and levers to further implementation. Using Excel, the PI calculated descriptive statistics to analyze the data at the end of Cycles 1 and 2. The analysis included the number of patients seen, the number and percent of eligible patients, screened patients for each cycle, and the risk level for each screened patient. The project implemented the ORT-OUD screening with 78 patients in two PDSA cycles (Cycle 1, n = 13; Cycle 2, n = 65). The screening identified 16 patients (21%) as high-risk and 33% of patients had one or more risk factors. Opioid risk screening can provide valuable information when assessing and treating patients receiving long-term opioid therapy for chronic non-malignant pain (CNMP). This project successfully implemented an opioid risk screening protocol using an interdisciplinary team approach.

Keywords: opioid therapy, overdose, risk assessment, opioid risks

Available for download on Friday, April 12, 2024